If timely detected, the disease can be arrested. The patient will need drugs, especially corticosteroids like predJ;lisolone, etc. This drug has its own side effects and needs to be tapered. Many a time, as soon as the drug is tapered, a relapse occurs, and again the dosage of the drug has to be increased, and this goes on in many of the cases. However, spontaneous and temporary remission may also occur.
With the control of proteinuria by administering the above drug, oedema decreases/subsides. A good way to see the prognosis of the disease is a daily check up of 24 hour urine for albumin, and look for improvement in the swelling of the feet/body of the patient.
Since, as a result of proteinuria, there is loss of protein in the blood (hypoproteinaemia), the patient is given a high protein diet. Pure protein, available in different preparations, like powder or biscuits, is prescribed. And, a constant watch is kept on the level of protein, both in the blood and in the urine, and the diet is accordingly adjusted.
As regards high levels of blood cholesterol (hypercholesterolaemia), which is also an important manifestation of this disease, specific measures explained in Chapter 5 on cholesterol should be strictly followed. This aspect of the treatment should be given equal weightage, and one should not concentrate entirely on the aspect of proteinuria/ hypoproteinaemia.
In case NS occurs as a result of any other cause like diabetes mellitus/ amyloidosis, besides the above line of treatment, the patient should be investigated/treated on the lines of the underlying disease, which may require urgent control.
If prednisolone alone does not work, other drugs are also available, which can be tried along with prednisolone, in selected cases. The patient is also put on diuretics to relieve the swelling/ oedema of the body. A daily record of body weight also gives a fair idea of the reduction in the swelling of the patient s body. The patient may need antibiotics to prevent secondary infection in the urinary tract or elsewhere.
The sad part of the disease is that in the absence of specific treatment or cure, especially in late cases, which are difficult to control, it may progress to the chronic stage, i.e. chronic GN, which may result in kidney failure. Hence the value of the awareness of early detection of the disease, i.e. by a simple examination of urine for albumin, is the key to the speedy control of the disease.
Prophylaxis of Glomerulonephritis (GN)
Since an attack of acute GN occurs as a result of sore throat, prophylactic steps should be taken to eradicate the infection in the entire family, and ideally in the whole community, where a particular case has occurred, so that further spread of infection can be prevented. The patient, as well as other associated persons, should be treated for sore throat with a suitable antibiotic. If possible, culture and sensitivity should also be carried out after taking throat swabs, and the antibiotic indicated in the culture report should be given. Immediate treatment should be taken in cases where the culture shows the growth of beta haemolytic streptococcus, responsible for sore throat/ an acute attack of GN. Such urgent measures may save various other members of the family/community from an attack of acute GN.
Since a sore throat infection is the main culprit in such acute case, general measures are required to prevent its incidence in masses. Overcrowding, highly populated areas, especially like the slums, should be avoided as far as possible. In other words, living conditions have to be improved. A patient with a sore throat should take an antibiotic at the earliest, and keep himself/herself isolated, so that the infection of throat does not spread to others, while coughing, etc. The patient coughs out droplets of sputum, contaminated with organisms, into the air, which may be inhaled by other persons, and hence the infection spreads in a family / community.
Hence general measures regarding the prevention of sore throat, as well as its prevention in a community/family, who are likely to contract sore throats, are urgently needed, so that the disease can prevented, and its further spread arrested.
At the same time, steps should be taken to detect hidden cases of GN as early as possible, so that the disease can be brought under control, and further progress, including fatal complications, prevented. For this, the only way is to examine the urine for albumin in a population, preferably through various medical camps, periodically, say, six monthly/yearly, as in the case of UTI, so that if the disease is suspected, it can be diagnosed, and treated.
Further, the public should also be made aware of this disease, so that patients can report to the physician for timely action.
Hence, prevention of sore throat and the early detection of GN are strong measures for the overall control of this disease.
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